Patient care dilemmas

4:11 May 27, 2015

A survey of almost 4000 medical and healthcare students from across the United Kingdom has found that more than half of those questioned indicated that they had witnessed clinicians breaching patient dignity or safety during the past year.

Similar numbers also reported witnessing the abuse of workplace colleagues – with over 75 per cent reporting being victims of abuse themselves.

The survey, carried out by researchers from Cardiff and the University of Dundee, also found that medical and healthcare students experience distress during and after these events, with women reporting greater distress than men. Although medical students reported less distress the more times they experience certain events (essential for learning), generally both medical and other healthcare students reported becoming more distressed with great exposure to them.

The results of the survey have been published online at BMJ Open.

“These findings around patient care dilemmas resonate with recent government inquiries into patient safety and dignity breaches in the UK,” said Dr Lynn Monrouxe, Director of Medical Education Research at Cardiff University and co-lead author of the research.

Professor Charlotte Rees, Professor of Education Research and Director of the Centre for Medical Education at the University of Dundee, said, “This is the latest piece of research from a ten-year programme examining medical, nursing, dental, pharmacy and physiotherapy students’ experiences of ethical and professionalism lapses.

“The findings have been consistent and illustrate the severe pressure students are frequently put under. More positively, the findings have prompted action by some education providers.”

In the latest survey, the researchers issued two questionnaires to understand the impact of professionalism dilemmas as experienced by UK healthcare students and the moral distress this placed upon them.

A total of 3796 students from across England, Northern Ireland, Scotland and Wales responded across both questionnaires. Although around 10% of respondents reported experiencing no professionalism dilemmas over the previous year, the remainder reported witnessing or participating in breaches of patient dignity or safety and the majority reported being victims of workplace abuse or witnessing the abuse of other healthcare workers.

Over half of medical student respondents reported undertaking an examination or procedure on a patient without valid consent following the request of a clinical teacher for the sake of their learning, while well over 25 per cent reported instigating this themselves.

“The findings around workplace abuse concur with previous research suggesting that student abuse and witnessing the abuse of others occurs as soon as students enter the clinical environment,” said Professor Rees.

Dr Monrouxe said, “We also analysed our data to see if self-reported moral distress intensity was associated with the gender of respondents and the frequency of occurrence with which they experienced these dilemmas. Females were consistently more likely to classify themselves as mildly, moderately and/or severely distressed compared with males.”

The researchers said their data also shows that, contrary to a widely held belief that medical and healthcare students suffer an erosion of empathy, these students actually maintain empathy throughout their undergraduate years.

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